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目的基于MRI分析探索初诊大脑半球胶质瘤瘤周水肿(peritumoral edema,PTE)特征对全切除术后复发部位趋向及复发形态的影响。方法收集来自4个临床中心43例经全切术后复发的胶质瘤病例的MRI资料,回顾性分析初诊时MRI的T2加权像所示PTE程度及类型对全切术后复发形态及部位趋向的影响。结果初诊胶质瘤PTE的特征对全切术后复发模式有显著影响,不仅复发形态在不同PTE程度间有明显差异(P=0.002),而且复发部位趋向在不同PTE程度间亦有明显差异(P=0.001),其中PTE程度轻者在复发形态上更倾向于局灶状(6/8),复发部位趋向易趋于原位型(5/8);PTE程度重者,复发形态易倾向于扩散状(30/35),复发部位趋向多为拓展型(25/35)、其次为周边型(7/35)。此外,全切术后复发形态在不同PTE类型间也存在明显差异(P<0.001),复发部位趋向在不同PTE类型间也存在明显差异(P<0.001),初诊时PTE为类圆型的复发形态以局灶状为多见(7/9),复发部位趋向多数为原位型(6/9),其次为周边型(2/9)和拓展型(1/9);PTE呈不规则的复发部位趋向绝多数为拓展型(25/34),其次为周边型(7/34),少见原位型(2/34)。结论大脑半球胶质瘤PTE的程度、类型对肿瘤全切术后复发形态、部位趋向有显著的影响。
Objective To explore the effect of peritumoral edema (PTE) characteristics of newly diagnosed hemispheric gliomas on the recurrence site trend and recurrence after total resection based on MRI analysis. Methods The MRI data of 43 cases of gliomas recurred after total resection were collected from 4 clinical centers. The degree and type of PTE indicated by T2 weighted images of MRI on first visit were retrospectively analyzed. Impact. Results The characteristics of newly diagnosed glioma PTE had a significant effect on the pattern of recurrence after total resection. Not only the recurrence pattern was significantly different between different PTE levels (P = 0.002), but also the recurrence site trend was also significantly different between different PTE levels P = 0.001). The patients with mild PTE were more likely to have focal lesion (6/8) in recurrence and the tendency of recurrence to tend to be in situ (5/8). The patients with severe PTE had a tendency of recurrence In the diffuse form (30/35), the recurrence sites tend to expand type (25/35), followed by peripheral type (7/35). In addition, there was a significant difference (P <0.001) in the recurrence patterns of total resection between different types of PTE (P <0.001). There was also a significant difference in the trend of recurrence sites between different PTE types (P <0.001) Morphology was more common in the focal area (7/9), the majority of recurrence sites were in situ type (6/9), followed by peripheral type (2/9) and extended type (1/9); PTE was irregular The majority of recurrence sites were extended type (25/34), followed by peripheral type (7/34) and rare in situ type (2/34). Conclusion The degree and type of PTE in cerebral hemisphere glioma have a significant effect on the recurrence pattern and site tendency after total tumor resection.